Lake Country Therapist

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LAKE COUNTRY THERAPIST

Doing business as

Lake Country Therapy

Practice address

354 Cottonwood Ave Ste C
Hartland, WI 53029-2011

Phone

(262) 290-3163

NPI assigned

Feb 18, 2022

Last updated

Apr 6, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Drake, LCSWNPI 1780223073

Title

Owner

Phone

(414) 405-5067

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Country Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Michelle Drake, LCSW

  • Clinical Social Worker
  • Hartland, WI
  • NPI 1780223073
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1962157826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N8263 WOODY LN",
            "city": "IXONIA",
            "state": "WI",
            "postal_code": "53036",
            "telephone_number": "414-405-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 COTTONWOOD AVE STE C",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530292011",
            "telephone_number": "262-290-3163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY THERAPIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-04-06",
        "certification_date": "2022-02-19",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-405-5067",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780223073",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Country Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Country Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle David Krueger, DDS
• Karin I Kultgen, M.D.
• David Paul Labs, RPH
• Lake Country Eye Care, LLC
• Lake Country Neurology and Spine Center
• Gabriele H Langan, PT
• Sean Davis Laroque, PH.D.
• Bethany Lato, LPC-IT
• Legion Transit LLC
• Grant A Lemke, DDS

• Clinical Social Worker in Hartland, WI
• Providers in Hartland, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.